Dental Amalgam Update

This summary is based on two critical appraisals published in the Journal of Esthetic and Restorative Dentistry:

Dental Amalgam Update—Part I: Clinical Efficacy (October 2013)

Dental Amalgam Update—Par t II: Biological Effects (December 2013)

Context 

Dental amalgam use has been controversial ever since the Crawcour brothers of France introduced amalgam to the United States in 1833. It has been criticized for its alleged clinical shortcomings and biologic effects.

Dental Amalgam Update—Part I: Clinical Efficacy 

Studies Reviewed

• Bonded amalgam sealants and adhesive resin sealants: five-year clinical results. Quintessence Int. 2004 May;35(5):351-7.
• Cross-sectional radiographic survey of amalgam and resin-based composite posterior restorations. Quintessence Int. 2007 Jun;38(6):511-4.
• Prevalence of cusp fractures in teeth restored with amalgam and with resin-based composite. J Am Dent Assoc. 2004 Aug;135(8):1127-32; quiz 1164-5.
• An Evaluation of Replacement Rates for Posterior Resin-based Composite and Amalgam Restorations in U.S. NAVY AND MARINE CORPS RECRUITS. J Am Dent Assoc. 2009 Feb;140(2):200-9; quiz 249.

Key Messages

• Dental amalgam can be bonded to enamel and dentin successfully.
• Limited studies suggest that preparations for dental amalgam restorations can be similar to those for resin composite restorations in some cases, depending on the clinical conditions encountered.
• Dental amalgam restorations are associated with lower rates of secondary caries than resin composite restorations.
• Amalgam restorations are not associated with a high incidence of complete cusp fractures.The incidence of complete cusp fractures is the same with dental amalgam restorations as it is with resin composite restorations.
• The replacement rate of dental amalgam restorations is more favorable than the replacement rate of posterior resin composite restorations.

Dental Amalgam Update—Par t II: Biological Effects

Studies Reviewed

• Dental Composite Restorations and Psychosocial Function in Children. Pediatrics 2012 (130[2]:e328–38)
• Neurobehavioral effects of dental amalgam in children: a randomized clinical trial. JAMA. 2006 Apr 19;295(15):1784-92.
• Immune function effects of dental amalgam in children: a randomized clinical trial. J Am Dent Assoc. 2008 Nov;139(11):1496-505.
• Biomarkers of kidney integrity in children and adolescents with dental amalgam mercury exposure: findings from the Casa Pia children’s amalgam trial. Environ Res. 2008 Nov;108(3):393-9. doi: 10.1016/j.envres.2008.07.003. Epub 2008 Aug 21.

Key Messages

• Dental amalgam restorations are not associated with detrimental psychosocial problems in children.
• Amalgam restorations are not associated with unfavorable neurobehavioral assessments in children.
• Amalgam restorations have no apparent effect on immune function in children.
• Amalgam restorations do not appear to affect renal function in children and have no apparent effect on the proportion of children with microalbuminuria.
• Because of its low replacement rate versus resin-based composite and its apparent safety, dental amalgam restoration should remain a viable treatment option.

 

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